Basic Information
| Provider Information | |||||||||
| NPI: | 1093386997 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KREIFELS | ||||||||
| FirstName: | JASON | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8336 PROVENCIA CT | ||||||||
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| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339128994 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4027704597 | ||||||||
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| Practice Location | |||||||||
| Address1: | 809 E MARION AVE | ||||||||
| Address2: | |||||||||
| City: | PUNTA GORDA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339503819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9416393131 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2021 | ||||||||
| LastUpdateDate: | 07/06/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 11013896 | FL | N | Allopathic & Osteopathic Physicians | Anesthesiology | 367500000X | 11013896 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.